Sunday, May 29, 2011

A nearly perfect ONE VOICE experience.....

Don't you just love when people actually let you do your job?? I don't really mean to be critical, but it's just so refreshing when people understand not only YOUR role, but also THEIR role!
I had a near perfect ONE VOICE experience on Friday....just thought I'd share it.
I work in an outpatient treatment center that services primarily oncology and solid organ transplant patients. If you need outpatient chemo, you come to us.(Now, I also cover the peds Hem/Onc clinic and radation oncology, but they're not the focus of my story today.) If you need a PICC line placed and you're outpatient, you come to us. If you need IVIG, lab draws from your port or line, outpatient antibiotics...you come to us. In our treament center there tends to be a core group of nurses who like to take the pedi patients, the others...not so much because"kids are harder." Friday we had a little 2 1/2 year boy who came in for IV antibiotics. He is a liver/small bowel/pancreas transplant recipient that I've met on a couple of occasions. He is in the custody of his grandma and she takes really good care of him.
Since a majority of our patients have lines or ports, I didn't even think about his possibly needing an IV...I was prepared with the toys to keep him busy for his 2 hour infusion. His primary nurse (nurse #1) was a nurse who doesn't often take care of our peds kids. She started to put "little dude" into the crib while another nurse (nurse #2....see how I name them so cleverly? It's a gift.) came in. Nurse #2  generally does take care of our pedi kids. I assumed they were doing their "checking the wristband" duty, but quickly realized they were going to start an IV.  Now...we all know that you sometimes have to tread lightly around staff you don't know quite as well, and since I didn't know nurse #1 my brain immediately went into the "Hey...hold on, I've got a better way to do this" mode.  All of a sudden, "Tra la la la"....nurse #2 said, "Why don't we do one of those 'sitting on the lap' holds you were showing us?" (Immediate internal heavy sigh of relief...we've got ourselves a believer!!)  Nurse #1, on the other hand, didn't have any idea what we were talking about but was willing to try. ANYTHING to make it easier was her motto. BEFORE I worked in the treatment center, I had done some inservicing with the treatment center staff about ONE VOICE. About this time last year, we were able to add a child life specialist to the treatment center; they've only been accustomed to someone bringing them toys in an emergency. It's been exciting to provide child life services to this area and define what that looks like. I've done a couple "quick inservices" about positioning and distraction for some of the staff and most of the staff have been very receptive to "trying something new."
At this point, I backed up the turnip truck and started where we should have started at the beginning, by asking G-ma what works with "little dude." She told us that he does really well sitting on her lap. Ding, ding, ding...we have a winner!!
From here on out, it was ONE VOICE heaven. Little dude sat on G-ma's lap, nurse #1 did the IV, nurse #2 assisted and I blew bubbles....the PERFECT scenario. G-ma knew exactly what her role was, she kept his other hand away. The nurses knew their job, to get the IV done and let child life do the distraction. Now...I've always had no problem producing hot air at a moments notice...talking is one of my greatest strengths (and weaknesses), so blowing bubbles is NOT a problem for me. (I can even do it with saliva. Oops...tmi)
Picture this: Little dude sitting side saddle on G-ma's lap, G-ma keeping little dude's hands away from the IV start, nurse #1 squatting down doing the IV, nurse #2 assisting, child life blowing bubbles, little dude popping bubbles and smiling. The only "oops" of this scenario was lack of EMLA. However, our transplant kids have such limited vein access, you'd literally have to slather them in EMLA...head to toe. Sadly for this little guy, he'd been poked enough in his short little life, that he didn't really fight a whole lot. He started to fuss...and then....the bubbles took him to his happy place. It was just a great situation...everything worked beautifully. Not only did this make it better for "little dude" and G-ma (who said the bubbles really made a difference...he usually resists), it also demonstrated the power of positioning, play, and not a lot of chatter going on. Nurse #1 and #2 got a dose, first hand, of creating a less threatening environment and how distraction can make a positive difference. Sometimes this is all it takes to get things started in the right direction....one positive encounter at a time....and I didn't even need to throw a shoe!

Tuesday, May 24, 2011

No one seems to be listening....can I throw my shoe??!

When I set out in 1996 to create an acronym that would teach people how to provide a less threatening environment for children undergoing medical procedures, I never dreamed I'd be blogging...probably because I didn't even know how to turn on a computer, and blogging wasn't even a word back then.  Honestly, during my senior year of college, Iowa State University decided it was about time to computerize the library. I never went back.

Here it is, 15 years later and people have been talking about "that ONE VOICE thing I heard about."  Did I dream 15 years ago that I would apply for a copyright on ONE VOICE, start my own website, present on ONE VOICE at the National Child Life Conference, create a PowerPoint to sell as well as other merchandise? Um....heck no!! Am I glad that I have and that I am??!! Heck yes!! What an exciting journey this has been!!  My main goal has been to empower other child life specialists to help health care professionals create a less threatening environment for our pediatric patients. I hope you enjoy the ride as much as I am!! Well....as much as I am now that I'm over the "I have so much to figure out but don't have any money and don't have a clue what I'm doing" phase. I still don't have it all figured out, but hey, it's definitely getting better!!

If you stumbled onto this blog by accident, click on the following link to see what the buzz is all about...http://www.onevoice4kids.com/

Probably the one question I get asked the most is, "How do I implement ONE VOICE? I totally believe in it, but I'm not sure the nurses will buy into it?"  That's a great question...and unfortunately, not one that has an easy answer.  (What?! This ONE VOICE lady doesn't have all the answers?!! Well as a matter of fact I do, but I can't always get everyone to listen either!!) This is what I've learned in my 20+ years as a child life specialist...contrary to popular belief, we can't always perform miracles. We don't always have our magic bubble wand, pop up book or iPad that is going to make everything all okay. What we DO have though, is a working knowledge that the elements of ONE VOICE will absolutely make a difference to the children we serve! We just have to get the staff to listen....not always the easiest of tasks.
My best advice is this; start with the ONE VOICE PowerPoint Presentation. There is enough information in this presentation to back up what we're saying. It gives the components and the rationale. Not only is it a great tool to teach child life students about creating a less threatening environment, it also has a lot of information geared toward the medical staff who "just don't think like a child life specialist." Do you have staff that need to have research behind it in order to believe it? The PowerPoint has it.

What I've found is that usually, each person attending the PowerPoint presentation will identify with at least one element of the ONE VOICE philosophy; there will be at least one thing will make sense to them.  (What??!! Won't they just take my word for it that it all works? Um...no. If they do, then call me...I'll want to meet them!)  If you stop to think about it, getting a staff member to buy into one element of ONE VOICE is probably better that what you had when you woke up this morning, right? But what happens if another nurse doesn't buy into the same component?  What if he or she actually makes sense out of a different component? Ahhh....this is the beauty of it all. What inevitably will happen is that they will convince each other that the component they believe in, makes sense. Now instead of having staff that might have only believed in one component, you may now have staff that believe in two components...and you didn't even have to call in back up!! Once you've got them talking, you just need to make good examples of what you see them practicing, "Wow. It really made a difference when you let that little girl sit on her mom's lap. I know she still cried, but it really made a difference to both the patient and her mom!"  See where I'm going with this? Chances are, different components will speak to different people so hopefully this will work to your advantage!

From here, now you just keep it fresh in everyone's minds by talking about it, making good examples out of those practicing the ONE VOICE components, and with the ONE VOICE posters and ID name badge cards.  (All ONE VOICE merchandise is available from http://www.onevoice4kids.com/) The posters work really well when placed in break rooms, staff bathrooms and when tattooed to staff foreheads!!! (Remember...if you DO decide to go the "tattooed foreheads" route...make sure you practice ONE VOICE!)